ESR - always low in ME??

I don't think it's run routinely in the U.S., but it's a very inexpensive test. The blood is allowed to sit, and the rate of settling of the red blood cells is measured. I think doctors are more likely to order it if they are checking for inflammation.

Looking through my notebook, I found three tests in the last two years. In 2010 it was zero, last year it was 4, now it's up to 5. Meanwhile other inflammation markers are also showing up as I continue to get sicker. Two years ago the ANA screen was negative. Now it's slightly elevated. Also a recent 'single stranded DNA' test was elevated, which is supposed to be yet another non-specific marker of inflammation.

In spite of my symptoms and inflammation markers, the rheumy concluded, "There are no signs of autoimmune disorder. We can't help you, and we don't know who can."

Below is the abstract of a paper about ISAC in CFS by David Berg et al. I don't think he mentioned the low sed rate in this paper, but he has mentioned it in talks he has given. Several years ago there was a dialog between him and the moderator of the Yahoo CFSFMExperimental group, Ken Lasessen, and quite a discussion of it in that group. He still gives talks these days, though he sold his lab. I see in the latest Townsend Letter that he is on the program to speak at a conference sponsored by Researched Nutritionals in Phoenix on Sept. 15-16, 2012, together with Joe Burrascano, Steven Fry, Carol Ann Ryser and others. His work is viewed as valid among the more alternative and integrative docs, but I don't think that most of the mainstream medical community recognizes the significance of low sed rate.

Chronic Fatigue and/or Fibromyalgia have long been diseases without definition. An explanatory model of coagulation activation has been demonstrated through use of the ISAC panel of five tests, including, Fibrinogen, Prothrombin Fragment 1+2, Thrombin/ AntiThrombin Complexes, Soluble Fibrin Monomer, and Platelet Activation by flow cytometry. These tests show low level coagulation activation from immunoglobulins (Igs) as demonstrated by Anti-B2GPI antibodies, which allows classification of these diseases as a type of antiphospholipid antibody syndrome. The ISAC panel allows testing for diagnosis as well as monitoring for anticoagulation protocols in these patients.
PMID: 10695770

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RIP to Rich. I just wanted to bump this up because it matches exactly what is going on with me.

APA can manifest a 100 different ways. It would make allot of sense if some cases of CFS are caused by APA.

This is a Q and A from the next issue of the MEA magazine on the subject of the CRP (C-reactive protein) test - which is used instead of, or in parallel, with the ESR test:

QUESTION: CRP blood test

I've been feeling generally more unwell for several months – so my GP has done some blood tests. They were all reported to be normal - apart from a slightly raised level of one test called a CRP. This is now going to be repeated. What is this test? Is it something that can be raised in ME/CFS? And what happens if it remains raised?

ANSWER

The CRP (C-Reactive Protein) blood test is a very useful but non -specific marker for infection or inflammation in the body. So if the CRP level is raised, it suggests that there is some form of infection or inflammation occurring somewhere in the body - even though there may not be any obvious symptoms or signs that would help to demonstrate where in the body this is occurring.

The CRP test is not therefore diagnostic of any particular infection or inflammation - as there are many possible explanations for a raised level. These can range from specific infections through to inflammatory bowel disease, arthritis, and autoimmune diseases such as lupus/SLE. The level can also be raised in the later stages of pregnancy, when taking the contraceptive pill or HRT, and with obesity.

The CRP test, or a similar one called the ESR (erythrocyte sedimentation rate), should always form part of the raft of blood tests that are checked, and reported to be within normal limits, when a diagnosis of ME/CFS is being made or considered. When something is wrong, the CRP test usually rises and falls faster than the ESR test.

In the case of ME/CFS, both the CRP and ESR test results should be within normal limits - but there are some circumstances (e.g a recent infection) where they might be raised.

If the level is slightly raised, the test will probably be repeated. If the level remains raised, or is significantly raised, this should lead to a thorough re-evaluation of your clinical symptoms and some further investigations to try and find the cause. I assume from what you are saying that consideration has been given to conditions that are sometimes misdiagnosed as ME/CFS, and which do cause an elevation of the CRP level - lupus/SLE for example.

Where the CRP level remains persistently raised, and the GP cannot find an explanation, referral to a hospital specialist will probably be necessary.

· The use of ESR and CRP tests in ME/CFS are described in the Investigation section of the MEA purple booklet

The tests available in the US can't differentiate between IgM and IgG; they essentially measure both. Yes, Equilibrant and lamivudine. I've had mild progress symptom wise but my antibody titer hasn't budged in over a year.

My son and I got ME at the same time and have had essentially the same symptoms.
He has had low ESRs (4, 4 and 2) but normal CRP (with one slightly high value).
My ESR has been normal (with the one high spike) but my CRP is consistently slightly elevated (10-20).

It's possible we have different, complicating infections as well as ME or that different genes are having an impact.

My son and I got ME at the same time and have had essentially the same symptoms.
He has had low ESRs (4, 4 and 2) but normal CRP (with one slightly high value).
My ESR has been normal (with the one high spike) but my CRP is consistently slightly elevated (10-20).

It's possible we have different, complicating infections as well as ME or that different genes are having an impact.

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Hutan. very interesting. how did your illnesses start?

what is the ref range for those low ESRs?

it seems like a lot of these tests are only a vague indication at best, and can even steer you down the wrong path.

@knackers323
Our illnesses started with severe gastro pain/flu. My daughter also got sick at teh same time and was hospitalised for three days with suspected appendicitis but that was later ruled out. We all remained unwell, going through periods where certain symptoms were prevalent eg joint pain, gastro issues, numbness. My daughter essentially recovered after 2 years. My son and I are much better than we were in the first year but not able to do much in the way of work/school.

The ref range for ESR that I have is <15. The labs here don't seem to see low ESRs as a problem worth highlighting.

Yes, I certainly wouldn't be trying to make ME subgroups based on ESR and CRP values.

Mine has always been high. If a high ESR negated M.E., then I've been misdiagnosed for nearly a quarter of a century! I find it a bit weird that a doctor (think it was Cheney) would rule out M.E. if the ESR is not low. I'd love to know what is wrong and with me, if it is not that.